Up-Charge

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There are many types of salesmen known for luring customers in with an offer that can’t be refused. Before you know it, you have agreed to buy a product with more features than you need and you’ve paid an up-charge that has busted your budget. An ambulance company slapped the government with some fraudulent up-charges, but an internal employee slapped back by blowing the whistle on her employer for the illegal practice.

The former billing manager for the company alleged that the ambulance company billed Medicare for transports that were not medically necessary. On top of that, the unqualified claims were up-coded in order to receive more money back from the federal health care program. (False information was added to the ambulance run documents to make them appear to be Medicare eligible.)

The whistleblower tried to correct the fraudulent billing, but was terminated from her job after she continued to question the company’s practice of up-charging. After a three-year litigation process, the ambulance company and their related companies agreed to pay $12.7 million to settle the False Claims Act lawsuit. (The whistleblower will receive $3,556,000 for her efforts to stop the illegal practice.)

In addition, the ambulance company also must enter into a Corporate Integrity Agreement with the Office of the Inspector General (OIG). This means the company has to implement employee training, hire a compliance officer and provide annual status reports for the OIG to comply.

Congratulations to the whistleblower who had the courage to take on her deceptive employer and its up-charge scheme. The government has no tolerance for companies that try to make extra money off of a government benefits program. In the end, the ambulance was stopped from driving away with undeserved profits and the whistleblower profited from telling the truth.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”$12.7 Million Settlement in Whistleblower Medicare Fraud Case Against Mass. Agency,” published by EMSWorld on January 16, 2017.

BOSTON – January 13, 2017 – Jeffrey Newman Law, a law firm dedicated to representing whistleblowers nationwide has announced that MedStar Ambulance, Inc. and its related companies have agreed to pay $12.7 million to settle a False Claims Act lawsuit alleging the company fraudulently billed Medicare for unqualified ambulance services.

The whistleblower, former billing manager Dale Meehan, represented by Attorney Jeffrey Newman Esq. of Boston, alleged MedStar knowingly and fraudulently billed Medicare for ambulance services by billing for ambulance transports that were not medically necessary and by up-coding the runs to exact higher payments from the government.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.